Therapy of Fibrinous Membranes in the Anterior Chamber With Intracameral Tissue Plasminogen Activator After Cataract Surgery

Friday, April 17, 2015
KIOSKS (San Diego Convention Center)
Kadir Eltutar, MD
Tulay Alpar Akcetin, MD
Nurhan Dincer, MD
FÝlÝz Filiz Özveren, MD
Yildiz Acar Ebcim, MD

Purpose
To evaluate the efficacy and complications of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous membrane after uneventful cataract surgery

Methods
In this retrospective study 14 eyes of 14 patients after uncomplicated cataract surgery were considered between March 2013-May 2014. Despite intensive topical-subconjunctival corticosteroid therapy, there were severe fibrinous anterior chamber reactions in the early postoperative period. Because of this, 25 µg of r-tPA was applied intracamerally. Patients were evaluated for complete fibrinolysis, recurrence of fibrious membrane or complications by slitlamp biomicroscopy 2, 12 and 24 hours, 2 and 7 days, 1 and 6 months after r-tPA application. In addition intraocular pressure (IOP) was measured by Goldmann applanation tonometry. Visual acuity was evaluated using a standard Snellen chart 1 week after r-tPA application.Mean age was 69±0.71 and male-female ratio was 6/8.Four of patients with fibrinous reaction had diabetes mellitus (DM), 3 of cases had glaucoma,1 had uveitis history.

Results
3 patients had pupillary block glaucoma due to fibrinous membrane.After topical and systemic anti-glaucoma treatment, peripheral iridotomy and membranotomy with Nd: YAG laser, IOP decreased to normal levels but the fibrin membrane was not resolved. Various degrees of posterior synechiae were noted in the other 11 patients. After injection of r-tPA,fibrinous membrane was completely dissolved and posterior synechiae were fully opened in 2-24 hours in all patients. In 2 patients with DM and in the patient with uveitis, a second injection was required as a result of recurrent fibrinous membrane. The day after the injection, fibrinous membrane was completely resolved. 6 eyes had transient corneal edema. Visual acuity improved by 2 to 6 lines in all patients. No patient had an increase in IOP , hyphema or recurrence.

Conclusion
Intracameral recombinant tissue plasminogen activator is a safe and effective therapy in eyes with anterior chamber fibrinous membranes, which do not respond to intensive corticosteroid therapy.